A few years ago, some US states began requiring that pre-teen girls receive a new vaccine against cervical cancer. The vaccine protects the girls from a sexually transmitted virus. A public debate erupted. Some parents protested that giving the vaccine sends a message that it's okay for their daughters to be sexually active at a young age.

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Now other countries are adopting the vaccine. In at least one country, there's been surprisingly little controversy, but that lack of controversy raises a new set of concerns. “The World’s” Karen Weise reports from Panama.

Christina Garcia sits down in a small green room at an urban health center in Panama. A nurse takes out a needle and syringe. Seconds later, the nurse pierces her left arm, and soon Christina is on her way. Christina's vaccine helps protect against human papillomavirus, or HPV, the sexually transmitted virus that causes cervical cancer.

Last fall, Panama became the first country in Latin America to make the HPV vaccine mandatory, and free. The government is vaccinating all girls when they turn ten years old. Panama's Minister of Health, Rosario Turner, says women's health is a high priority for the government. She says cervical cancer is Panama's second leading cause of death for women. Here, women don't frequently get pap smears, so vaccinating girls is the most effective way to protect them.

The Health Ministry is spending five million dollars a year on the program. That's a lot of money for this small, developing country. The health minister says in just the first few months of the program, Panama has vaccinated 19,000 girls. And that's not just in big cities, but in small villages too.

One of those villages is El Capuri. It's surrounded by grassy hillsides where the jungle's been cleared for cattle. El Capuri has 100 residents, including two ten year-old girls. One is Rosemary Samaniego. Rosemary remembers getting the first dose of vaccine at school back in November. Then her mom took her to a local health center for a second dose a month later. Rosemary still needs a third and final dose for the vaccine to be fully effective. Rosemary's mother, Rosa Samaniego, says she's grateful that the vaccine program reached El Capuri. Her aunt had ovarian cysts, so Rosa says she wants to protect her daughter from gynecological problems.

Across Panama, parents have almost universally welcomed the HPV vaccine. That's unlike in the US, where a vocal minority objected. There's a simple reason there's no controversy, according to Jose Cedeño from Planned Parenthood's Panamanian affiliate. He says the government hasn't told parents that the vaccine protects against a sexually transmitted virus. “They said that this prevents just cancer.”

That message, that it's just a cancer vaccine, is central to how the government promotes the program on TV and radio. In this government public service announcement, a girl asks her parents to protect her future by vaccinating her against cancer. There's no mention of sex.

Jose Cedeño from Planned Parenthood says the government is failing to provide families with full information. He says Panama has no national sex-ed program, and the Health Ministry is squandering an opportunity to educate the public. “People need to receive all the information, and to take better decisions related to their sexuality.”

He points out that the vaccine isn't completely effective. It doesn't block the strains of HPV that cause about a third of cervical cancer. And he's concerned about girls older than 10, who aren't vaccinated for free. Cedeño says girls need to learn how to protect themselves. They should consider abstinence. They should insist that sexual partners use condoms.

Panama's Health Minister, Rosario Turner, acknowledges that her department explicitly downplays the links between HPV and sexuality. Turner says she saw the outcry over the HPV vaccine abroad and tried to avoid it by focusing only on cancer. In Panama, parents can be sensitive about discussing sexuality. Last fall, the government tried to introduce a comprehensive Sex Ed program in schools. But a huge debate ultimately crushed the effort. Many in the public health community believe the government is doing the right thing by downplaying the sexual nature of HPV.

Newton Osborne is a prominent Panamanian gynecologist. “I think it's a good thing because if they tie it into sexual activity, it's going to bring up all kinds of controversy that I don't think is going to be that relevant to the main issue: we want to prevent women from getting cancer.”

The ministry's approach has allowed the government to do what it set out to do, quickly vaccinate a lot of girls. And Panama's approach may soon be copied elsewhere. Mexico recently launched an HPV vaccination program in high-risk states. Authorities there are also promoting it as a "cancer vaccine."

Several countries in the Caribbean are in their early stages of developing programs, and they too will have to decide if getting the public to accept the vaccine will require hiding the role that sex plays in spreading the virus, and causing cervical cancer in the first place.

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